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First-trimester cord entanglement in monoamniotic twins
T G Overton1, M L Denbow, K R Duncan
1Centre for Fetal Care, Imperial College School of Medicine, Queen Charlotte's, London, UK.
Summary
Early diagnosis of monoamniotic twinning is crucial. Color Doppler ultrasound in the first trimester can now detect cord entanglement, a key indicator of this high-risk twin pregnancy complication.
Area of Science:
- Perinatology
- Maternal-Fetal Medicine
- Diagnostic Ultrasound
Background:
- Monoamniotic twinning, occurring in 1% of twin gestations, is associated with significant perinatal mortality.
- Timely and accurate diagnosis of monoamniotic twinning is critical for implementing interventions to mitigate complications.
Purpose of the Study:
- To report a novel method for early, reliable diagnosis of monoamniotic twinning.
- To demonstrate the utility of color Doppler ultrasound in identifying umbilical cord entanglement in the first trimester.
Main Methods:
- Two twin pregnancies were assessed in the first trimester using pulsed and color Doppler of umbilical arteries.
- Umbilical cord entanglement was identified by analyzing fetal heart rate patterns in a common cord vessel mass.
Main Results:
- Differing fetal heart rate patterns in the same direction on Doppler analysis indicated cord entanglement.
- Medical amnioreduction was performed at 20 weeks to manage fetal movements and cord entanglement.
- Delivery occurred via Cesarean section at 32 weeks, confirming monoamniotic twinning.
Conclusions:
- A new sonographic sign for first-trimester monoamniotic twinning diagnosis is presented.
- This method may enhance the reliability of early diagnosis for monoamniotic twin pregnancies.
- Further research is needed to establish the prevalence of cord entanglement by the end of the first trimester.